Sunday, April 26, 2020

Melanoma treatment guidelines from Melanoma Big Dogs


As much as we've learned about melanoma, there remains much we do not know.  Yet, even with the limited available treatments, the stage and indications for use, what to do about side effects, what to do next, remains confusing for patients and oncologists alike.  To that end, I put together this primer a couple of years ago:  Melanoma Intel: A primer for current standard of care and treatment options  (Unfortunately, to date, it has required no up-dates other than the dosing schedule for nivo!)

There is also this post regarding adjuvant treatment, including data from a presentation made by Jeff Weber, MD (Melanoma Big Dog extraordinaire!): ADJUVANT therapy for melanoma!!!!!!!!!!!!!! State of the science....

And finally, also with the help of Weber's presentation, what may be coming in the way of immunotherapy and other treatments:  The future of immunotherapy and cancer - per Weber

 You can find more articles on most any particular treatment by entering the word in the search bubble to the top left if you are interested.  Now, as we head into ASCO 2020, Melanoma Big Dogs have put together guidelines for the use of systemic therapies in melanoma ~

Systemic Therapy for Melanoma: ASCO Guideline.  Seth, Messersmith ... Weber ... Agarwala, Ascierto ... Faries ... Sondak, et al.  J Clin Oncol. 2020 Mar 31. 

To provide guidance to clinicians regarding the use of systemic therapy for melanoma, ASCO convened an Expert Panel and conducted a systematic review of the literature.

A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma.

In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in BRAF-mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with BRAF wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in BRAF-mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at www.asco.org/melanoma-guidelines.

Click on the link included to search for specifics from the guidelines.  Hang tough peeps.  We're getting there! - c

2 comments:

  1. Hopefully ACT will get approval this fall and be another tool we have....Im 1 year out and NED.

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  2. For those of you who are reading and don't know what ACT is - there is this:

    Adoptive cell transfer therapy, or ACT, includes a number of different types of immunotherapy treatments. They all use immune cells that are grown in the lab to large numbers followed by administering them to the body to fight the cancer. Sometimes, immune cells that naturally recognize melanoma are used, while other times they are modified to make them recognize and kill the melanoma cells. There are several types of ACT:

    TIL (tumor-infiltrating lymphocytes): This is when T-cells are grown from the tumor itself
    Endogenous T-cell therapy: This is when tumor-specific T-cells are grown from the blood
    CAR T: This is when a chimeric antibody/T-cell receptor gene is put into peripheral T-cells
    TCR transduced T-cells: This is when a T-cell receptor gene engineered to recognize tumor is put into peripheral T-cells

    Hopefully, these therapies will prove effective and safe for more melanoma patients and as such gain FDA approval making them more widely available. Given the toxicity and risk of current TIL therapy, I suspect until more breakthroughs are made, many of these treatments - even if approved - would be used after failing conventional targeted or immunotherapy.

    However, I remain hopeful that more therapies will be discovered, tested and approved. I wish you well, Mike. C

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